Steps

1

Do the prerequisite Reading. Read about the disease and procedure prior to any operation.

Call the Attending Surgeon for calls about patients, consultations about trauma, or for help if necessary with difficult trauma problems. Always call The Attending Surgeon when you admit a patient to his/her service or when one of his/her patients has an untoward event – no matter what time of day or night!!!

2

Attend the clinic. The Attending Surgeon likes to see all the patients if possible. The Attending Surgeon should see every patient whose care is not obvious and straight forward and all medicare patients.

Method1

Operating Room

1

Keep good notes. Pre-op notes should be written for all of The Attending Surgeon's patients in including day op patients. Results of every ordered test should be in the notes.

The Attending Surgeon will want to have a pre-op note written on all of his/her patients (chest x-ray, EKG, laboratory, culture). On outpatient surgery, these notes should be written at least the day before surgery and then put in the chart the day of surgery (the objective of a pre op note is to be sure that we do not operate on a patient who is not in condition for surgery – checking labs after the patient is asleep will not accomplish that goal!) The Attending Surgeon will be especially unsatisfied with notes documenting that laboratory or other tests have been ordered but not documenting their results. If this material is not documented, the PGII responsible will assist only. Contact The Attending Surgeon about any problems IN ADVANCE.

Method2

Consent

1

There should be a note in the chart documenting that you have spoken to the patient about 1 or 2 common complications (infection, nonunion) and 1 or 2 catastrophic complications (death, NV injury) and the patient still consents.

2

The Attending Surgeon wants the x-rays up in the OR on all patients - even “scopes”.

Method3

Prep

1

Check to be sure that no folds of skin have been caught in the tourniquet – There have been full thickness skin losses under a tourniquet. When the area is dirty, wash the skin with chlorhexidine soap on an OR towel, wipe it clean, then prep with Duraprep/Prevail. Duraprep alone is fine for clean elective surgery. Prep external fixators with alcohol before prepping the skin with Duraprep.

Method4

Arthroscopy

1

The Attending Surgeon feels that an adequate challenge to your motor learning skills is that you fully master the ability to “drive the scope”. With certain of the more easily treated lesions, The Attending Surgeon will hold the arthroscope while you resect the lesion. Attempts to have someone at the PGII level try to both drive the scope and operate on a lesion has resulted in frustration for both you and The Attending Surgeon.

Method5

Procedures in general

1

Think of a surgical procedure as being carried out by a team rather than by a specific surgeon. It is very inappropriate to attempt to carry out part of the dissection backhanded rather than simply handing the instruments to the surgeon on the opposite side of the table who can reach that portion of the wound easily. The same is true of any other parts of a procedure for which another member of the team is better positioned.

Method6

Postoperative Care

1

The Attending Surgeon will attempt to talk to the families of all surgical patients immediately post-operatively.

If The Attending Surgeon goes directly from one surgery to another, You should try to speak with the family.

Method7

Presentations

1

Below is a sample presentation for presenting cases in the clinic. The object of the presentation is to concisely transfer information from your brain to the presenter and to learn how to make an assessment and plan. Going over your presentation in your own mind several times while waiting for the presenter – sorting the wheat from the chaff will help you make an assessment and making an assessment will help you sort the wheat from the chaff. The Attending Surgeon doesn't care whether your assessment and plan is “correct”, The Attending Surgeon just wants you to make the attempt.

Method8

EXAMPLE PRESENTATION

1

Mr. Smith is a 30 year-old, obese, insulin dependent, diabetic male who injured his knee three months ago. He was felt to have a medial collateral ligament injury and treated with a brace and Ibuprofen 800 mg TID.

2

EXPLANATION

This identifies the patient.

It gives a brief description of him and his major illnesses, and lets the listener know what our previous thought process has been regarding his condition.

Usually, “Subjective” follows “Identification”. My assessment is that the patient has a tear of the posterior horn of his medial meniscus.